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Of Birds & Bees

The Ticking Clock

Singapore’s Total Fertility Rate stands at an abysmal 1.2—way below what the population needs to replace itself. Some of that is the result of people choosing not to marry; some from couples having very few children—either by choice or because having children has proved difficult.

Dr Christopher Chen of the Christopher Chen Centre for Reproductive Medicine, comments, “If, despite regular intercourse every two to three days, pregnancy does not occur after six months to one year, then the couple may have fertility problems. The problems could be due to either the man or the woman, or combined.”

Age is a huge factor in fertility.

With couples marrying increasingly later and putting off having children— often to complete higher education and establish careers and finances— age-related fertility issues have become more common. “A woman’s fertility declines after the age of 25 initially slightly, but becomes quite precipitous after the age of 40. By the time she reaches 45, her prospect is very poor,” reveals Dr Chen. “Age also influences a man’s fertility. After the age of 50, there is a progressive decline in the man’s fertility and sexual performance.”

Adds Dr Ann Tan of the Women and Fetal Centre, “With increasing opportunities for more women to be educated and develop their careers, fertility has taken a back seat. In many women’s minds, it is something that can be summoned at will when they need it.”

That points to a host of lifestyle and societal factors that impact fertility. Education and career success sometimes take priority over having children. And, as Dr Tan points out, people often take their fertility for granted. A fast pace of life, stressful jobs and lack of work-life balance also take their toll.

As Dr Chen puts it, “Modern living has clearly had an impact on the fertility both of men and women, especially in a fast-moving, demanding and stressful environment such as Singapore, where many people work long hours and travel for business. The lack of opportunity for a couple to have intercourse amid their busy schedules has an impact on fertility and on general health.”

He continues, “Undoubtedly, mental, physical and emotional stresses have been found to impact fertility. In the man, it affects his sperm quality and count. In the woman, it can affect her ovulation. She may not ovulate over several periods of her cycles; she may produce poor quality eggs on account of these factors.”

Let's Talk About Sex

Ultimately, for a couple to conceive a child, they need to have sex.

That’s stating the obvious, but it’s shocking how little sex many couples have. A range of factors contribute to this, of which lifestyle and stress are two large ones.

“Couples need to look realistically at improving their lifestyle to give them opportunities to relax and to have intercourse, especially during the woman’s fertile period,” suggests Dr Chen. “Modifying their work environment and changing jobs can be considered. Ultimately, couples need to make time to be together and to have more frequent intercourse. The best time for a couple to conceive is between Day 11 and Day 16 of a 28- to 30-day menstrual cycle.”

And what about the stress that trying to conceive a baby can in itself bring to a couple? “Making a baby should not be perceived as a chore,” advises Dr Chen. “Couples who take it easy in conceiving are more successful than those who try hard. Sex should not be regimented; it should be enjoyed. The couple should create a conducive environment for lovemaking and not just aimed at baby-making. The couple should combine the pleasure of sex and the pleasure of conception.”

The TCM Perspective

In traditional Chinese medicine (TCM) principles, the most important organs that govern the regulation of blood and qi and their related activities are the liver, spleen and kidneys. The spleen is the main ‘factory’ that produces blood and qi, while the liver is responsible for maintaining a smooth and even flow of these two important essences. According to Senior Physician Zhong Xi Ming from the Eu Yan Sang Premier TCM Centre, when it comes to fertility, “the kidneys play a big role in successful conception and normal reproduction.”

How does TCM treat this problem? The first method is via herbal prescriptions, which aims to nourish and balance the body, especially the reproductive system, liver, kidneys and spleen. Acupuncture can regulate the function of the relevant organs to strengthen and invigorate the whole body. Diet and exercise may also come into play.

The overarching principle of TCM when it comes to fertility is to “cultivate the soil before planting the seed,” as Senior Physician Zhong puts it. “We treat holistically, taking into account your physical, emotional and spiritual aspect.” This means TCM does not only focus on treating a particular fertility-related problem. “We also want to improve all systems of your body and mind,” she reveals. “If you are sleeping well, are full of vitality, have proper digestion and healthy sense of self, then all systems will work more efficiently, including your reproductive system.”

Acupuncture and Reproductive Health

Acupuncture treatment regulates the flow of qi and blood, tonifying where there is deficiency, draining where there is excess, and promoting free flow where there is stagnation. Researchers from New York’s Weill Cornell Medical Center reviewed existing studies and found that acupuncture helps…

Reduce stress hormones that interfere with ovulation

Normalise hormones that regulate ovulation so an egg is released

Increase blood flow to the uterus, improving the chances of a fertilised egg getting implanted